WAMC/program list advice?

[ehwatsupdoc]

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edited

 

[Thama]

That's quite the spread of programs - looks like you are extremely committed to the NE. Nothing wrong with that, but understand that the program quality to competitiveness ratio becomes drastically more favorable in literally every other part of the country.

Your CV as stated should make you competitive for all but possibly the very top of your list. Also, any reason why no Columbia, Penn, JHU if you're shooting for top tier? You have Partners on your list which is probably even more competitive than those. Another to look at seriously in that region is University of Rochester - I've known several who have trained there and it's a really, really good neurology program in the NE that doesn't get looked at because it's off the urban path.

 

[90sportsfan]

That's quite the spread of programs - looks like you are extremely committed to the NE. Nothing wrong with that, but understand that the program quality to competitiveness ratio becomes drastically more favorable in literally every other part of the country.

Your CV as stated should make you competitive for all but possibly the very top of your list. Also, any reason why no Columbia, Penn, JHU if you're shooting for top tier? You have Partners on your list which is probably even more competitive than those. Another to look at seriously in that region is University of Rochester - I've known several who have trained there and it's a really, really good neurology program in the NE that doesn't get looked at because it's off the urban path.

I was thinking about the Philly schools too, and would include Penn and Thomas Jefferson; especially since MGH was listed (and Temple was listed). Philly is a clear Northeastern city/region.

Technically Hopkins (Baltimore/Maryland) is in the South, although many consider it to be a part of the greater NE, so I can see a Northeastern purist who wants to live in the heart of the NE (which it seems like the OP is looking for) may exclude Hopkins.

 

[ehwatsupdoc]

I just added the programs listed above, I must have missed those. Thank you!

 

[Thama]

Any insight into what does/doesnt make me competitive for the very top of the list? I'm assuming AOA is a big factor. Maybe research specifically in neurology?

Also, which of these would you consider very top? Thank you!

"Low tier" med school
Good but not great grades
Not a convincing trajectory for a budding clinician-scientist - pubs aren't 1st author and they aren't in a relevant field
AOA is a minor detail and being phased out in many schools as a biased indicator

None of these are absolute killers, but the overall picture isn't really what I've seen match into the absolute top tier. I've been in a fair number of rank list meetings at a relatively comparable program elsewhere in the country, and someone with your profile wouldn't be dismissed off-hand, but would need to make quite an impression to be ranked to match. In the NE, I would consider that group to be Partners, Columbia, Penn, and Hopkins. There are many other very good training programs, but those are the ones with the name and history to be the most selective, and tend to output the most funded researchers. As some point out, often the very best clinical training doesn't take place at these top tier programs, mostly because these programs are usually designed to provide schedule flexibility to allow residents to continue their research trajectory during PGY3-4 years. Realistically, programs of this type only *really* matter if you are quite certain that you want to spend the vast majority of your time and effort doing research, likely funded either by the NIH, other governmental agencies, or in conjunction with industry.

You miss all the shots you don't take. Apply to all the places you might want to go, take as many interviews as you can for places you might want to go, and rank what feels right according to your career goals. There is no "best neurology program" for everyone, and one program that fits someone like a glove might be a terrible idea for someone else. If you give some insight regarding your goals (subspeciality, academic interests, practice setting, location, lifestyle factors, etc) we might be able to be more helpful.

 

[xenotype]

"Low tier" med school
Good but not great grades
Not a convincing trajectory for a budding clinician-scientist - pubs aren't 1st author and they aren't in a relevant field
AOA is a minor detail and being phased out in many schools as a biased indicator

None of these are absolute killers, but the overall picture isn't really what I've seen match into the absolute top tier. I've been in a fair number of rank list meetings at a relatively comparable program elsewhere in the country, and someone with your profile wouldn't be dismissed off-hand, but would need to make quite an impression to be ranked to match. In the NE, I would consider that group to be Partners, Columbia, Penn, and Hopkins. There are many other very good training programs, but those are the ones with the name and history to be the most selective, and tend to output the most funded researchers. As some point out, often the very best clinical training doesn't take place at these top tier programs, mostly because these programs are usually designed to provide schedule flexibility to allow residents to continue their research trajectory during PGY3-4 years. Realistically, programs of this type only *really* matter if you are quite certain that you want to spend the vast majority of your time and effort doing research, likely funded either by the NIH, other governmental agencies, or in conjunction with industry.

You miss all the shots you don't take. Apply to all the places you might want to go, take as many interviews as you can for places you might want to go, and rank what feels right according to your career goals. There is no "best neurology program" for everyone, and one program that fits someone like a glove might be a terrible idea for someone else. If you give some insight regarding your goals (subspeciality, academic interests, practice setting, location, lifestyle factors, etc) we might be able to be more helpful.

Several big nuggets of truth, not just for OP but for all neurology applicants. The best research/prestige programs do not necessarily train you to be the best, most flexible 'swiss army knife' neurologist. It is one thing to do heavily sub-specialized referral neurology in a half day clinic and research in the same area the rest of the week along with grant writing/industry meetings. It is quite different to do community general neurology, see everything that walks in the door all week, and then take call for the ER and hospital over the weekend including acute stroke/seizure/whatever else they call about. The world needs both types of neurologists, but they are very different practices. I'd also add that industry funding cares much less about prestige, and much more about being part of a group that is already very well protocolized to deal with FDA compliance and get the patient population of interest enrolled quickly. Obscure sites in Poland can beat the pants off of Columbia with certain patient populations industry wants to study, etc.

Neurology is not *that* competitive overall, and I always think the focus on brand names can be short sighted depending on what one's goals are. Apply to a variety of programs that seem to fit with your individual goals and preferences and the process will work out, even if you don't get what you think is your #1. As for OP- 'high pass' on any neuro rotation kinda raises questions for the most selective programs- why couldn't that have been honors? Classically it is best to see honors medicine and neuro rotation grades at least. Maybe be prepared if an especially aggressive interviewer asks about that but most places are nice interviewers and won't ask.

 

[hiiiiiiiiiii]

Several big nuggets of truth, not just for OP but for all neurology applicants. The best research/prestige programs do not necessarily train you to be the best, most flexible 'swiss army knife' neurologist. It is one thing to do heavily sub-specialized referral neurology in a half day clinic and research in the same area the rest of the week along with grant writing/industry meetings. It is quite different to do community general neurology, see everything that walks in the door all week, and then take call for the ER and hospital over the weekend including acute stroke/seizure/whatever else they call about. The world needs both types of neurologists, but they are very different practices. I'd also add that industry funding cares much less about prestige, and much more about being part of a group that is already very well protocolized to deal with FDA compliance and get the patient population of interest enrolled quickly. Obscure sites in Poland can beat the pants off of Columbia with certain patient populations industry wants to study, etc.

Neurology is not *that* competitive overall, and I always think the focus on brand names can be short sighted depending on what one's goals are. Apply to a variety of programs that seem to fit with your individual goals and preferences and the process will work out, even if you don't get what you think is your #1. As for OP- 'high pass' on any neuro rotation kinda raises questions for the most selective programs- why couldn't that have been honors? Classically it is best to see honors medicine and neuro rotation grades at least. Maybe be prepared if an especially aggressive interviewer asks about that but most places are nice interviewers and won't ask.

Not to distract from OP's questions, but since you brought it up, I was wondering how much having an HP in medicine will effect my app at top programs. This is given that I have an H in neuro, high step score, first author pubs in neuro, and also am AOA. Will they still really about that HP? Just curious because this has crossed my mind before

 

[Thama]

Not to distract from OP's questions, but since you brought it up, I was wondering how much having an HP in medicine will effect my app at top programs. This is given that I have an H in neuro, high step score, first author pubs in neuro, and also am AOA. Will they still really about that HP? Just curious because this has crossed my mind before

You'll get questions and will need a convincing answer.

 

[hiiiiiiiiiii]

You'll get questions and will need a convincing answer.

Got an attending that only gives HP... jk I'll think of something that sounds good. Thanks!

 

[90sportsfan]

Several big nuggets of truth, not just for OP but for all neurology applicants. The best research/prestige programs do not necessarily train you to be the best, most flexible 'swiss army knife' neurologist. It is one thing to do heavily sub-specialized referral neurology in a half day clinic and research in the same area the rest of the week along with grant writing/industry meetings. It is quite different to do community general neurology, see everything that walks in the door all week, and then take call for the ER and hospital over the weekend including acute stroke/seizure/whatever else they call about. The world needs both types of neurologists, but they are very different practices. I'd also add that industry funding cares much less about prestige, and much more about being part of a group that is already very well protocolized to deal with FDA compliance and get the patient population of interest enrolled quickly. Obscure sites in Poland can beat the pants off of Columbia with certain patient populations industry wants to study, etc.

Neurology is not *that* competitive overall, and I always think the focus on brand names can be short sighted depending on what one's goals are. Apply to a variety of programs that seem to fit with your individual goals and preferences and the process will work out, even if you don't get what you think is your #1. As for OP- 'high pass' on any neuro rotation kinda raises questions for the most selective programs- why couldn't that have been honors? Classically it is best to see honors medicine and neuro rotation grades at least. Maybe be prepared if an especially aggressive interviewer asks about that but most places are nice interviewers and won't ask.

This is good to read as someone who will be applying to Neuro. It's really a hard choice because the one thing I like about the bigger name programs, is that residents seem to get lots of exposure to all of the different subspecialties at the big programs. Although as you said, it's kind of a double-edge sword because at smaller programs you likely get to "do" a little more and may get a little more everyday clinical experience due to less research elective time. You will will also be able to supplement with a subspecialty fellowship, and can come out clinically very strong.

From what I've been told, and what you seem to allude to, it is best to have an idea about your long-term goals. I am interested in academics with some research time, so I am leaning towards applying to and ranking some of the larger (research-focused) programs higher. But I can see strong applicants being interested in smaller programs that may be stronger clinically.

Although, from what I've heard on this site and witnessed at the program affiliated with my school, "academics" in Neurology is essentially more of a practice setting where you'll be working like you would be in private practice. There are a few MD/PhD-types who are NIH-funded and have lots of protected research time and very little clinic time, but the vast majority of neurologists don't fall into this category. For most neurologists, most of your week will be devoted to clinical practice and some teaching, with a little time available for research. Most of us will not have the available time to be able to conduct a lot of high-profile research (NIH/FDA funded); we will simply be practicing clinically in an academic setting.

 

[xenotype]

This is good to read as someone who will be applying to Neuro. It's really a hard choice because the one thing I like about the bigger name programs, is that residents seem to get lots of exposure to all of the different subspecialties at the big programs. Although as you said, it's kind of a double-edge sword because at smaller programs you likely get to "do" a little more and may get a little more everyday clinical experience due to less research elective time. You will will also be able to supplement with a subspecialty fellowship, and can come out clinically very strong.

From what I've been told, and what you seem to allude to, it is best to have an idea about your long-term goals. I am interested in academics with some research time, so I am leaning towards applying to and ranking some of the larger (research-focused) programs higher. But I can see strong applicants being interested in smaller programs that may be stronger clinically.

Although, from what I've heard on this site and witnessed at the program affiliated with my school, "academics" in Neurology is essentially more of a practice setting where you'll be working like you would be in private practice. There are a few MD/PhD-types who are NIH-funded and have lots of protected research time and very little clinic time, but the vast majority of neurologists don't fall into this category. For most neurologists, most of your week will be devoted to clinical practice and some teaching, with a little time available for research. Most of us will not have the available time to be able to conduct a lot of high-profile research (NIH/FDA funded); we will simply be practicing clinically in an academic setting.

Have to separate here- big program does not equal big name. Nor does it equal subspecialty exposure. Most residencies the residents are clustered in the hospital with minimal outpatient exposure. Ways this can be done better at some places: attendings not dumping garbage patients on resident clinics, curated effort to ensure resident clinics have continuity and complexity within subspecialty cases (rare), ensuring adequate enough outpatient rotations to cover all the subspecialty bases. The resident clinic is the most important piece, and the most neglected one. A brand name program has absolutely nothing to do with how good this clinical training is- if anything even more incentive to dump garbage patients with BS on resident clinics and ruin continuity because it is more convenient not to have it. My program for example had great continuity- many of my patients I consistently saw for 2-3 years. However variety was poor, and many of the cases the attendings did not want to see and dumped to the resident clinic. Nothing is perfect.

Big program is something like UMiami- huge classes more the size of an IM program. Nice for schedule coverage and getting time off when you need it. Has little to do with how good the training/volume/exposure to subspecialties is. UMiami while not a bad place by any stretch, is not a name brand like Harvard/Mayo/CCF and is more in the big swath of 'upper mid tier'. As I've said before, I don't think this has anything to do with how good the actual neurology training is. There are small places like Mayo satellites, Dartmouth etc with some name affiliation but you can imagine what a class size of 3 per year can do for your call schedule, and the real acuity and volume of the patients at those places.

If you spend your time doing substantial research in residency- that may come at the expense with how some programs are structured of clinical exposure, and for some people may make you uncomfortable at dealing with the full unfiltered breadth of neurology that exists in the community where you can't dump the patient on another subspecialist easily or quickly. Also- industry research has different goals, funding sources, needs, and often is not necessarily done in the name brand places that eschew industry relationships.